Value-Based Care
Transformation
Proven ROI across 147 health systems with $38.1M cumulative savings per 100,000 lives. CMS-approved reimbursement pathways with demonstrated quality score improvements.
$4,280
Per member per year savings
42% reduction in total cost
4.5★
Average Star Rating
0.8 star improvement
312%
Average ROI
18-month payback period
89%
Provider adoption
Within 90 days
Digital Therapeutics Integration
SaMD Class II
312%
ROI in Year 1
Cost Savings$4,280
Readmission-42%
Adherence89%
Coverage87% of commercial plans
Remote Patient Monitoring
CPT 99453-99458
287%
ROI in Year 1
Cost Savings$3,650
Readmission-38%
Adherence86%
CoverageMedicare + 92% commercial
AI-Assisted Care Coordination
CCM/PCM Codes
246%
ROI in Year 1
Cost Savings$2,890
Readmission-35%
Adherence82%
CoverageCMS approved
Precision Medicine Platform
Genomic + Digital
428%
ROI in Year 1
Cost Savings$6,120
Readmission-48%
Adherence93%
CoverageEmerging coverage
Cost-Effectiveness by Condition
Comprehensive economic analysis across chronic conditions demonstrates 58-72% cost reduction with digital therapeutic integration. ICER-validated models show cost-effectiveness below $50,000 per QALY threshold.
Annual Cost Per Patient ($)
Traditional Care
Digital Only
Integrated Model
Healthcare Utilization Reduction
-48%
ED Visits
-42%
Readmissions
-2.8
Avg LOS (days)
+31%
Preventive Care
Quality Metrics & Star Ratings Impact
HEDIS & Star Ratings Performance
HEDIS Depression Screening
★★★★★5 Stars
94%
Baseline: 62%Target: 90%
Medication Adherence
★★★★★4.5 Stars
89%
Baseline: 58%Target: 80%
HbA1c Control
★★★★★4.5 Stars
82%
Baseline: 54%Target: 75%
Blood Pressure Control
★★★★★4 Stars
86%
Baseline: 61%Target: 80%
Preventive Care
★★★★★4 Stars
78%
Baseline: 48%Target: 70%
Patient Experience
★★★★★5 Stars
91%
Baseline: 52%Target: 85%
Outcomes by Payer Type
Medicare Advantage
Enrollment
3.2M lives
PMPY Savings
$4280
NPS Score
72
Star Rating
4.5★
Commercial PPO
Enrollment
2.8M lives
PMPY Savings
$3650
NPS Score
68
Star Rating
4.2★
Medicaid MCO
Enrollment
4.1M lives
PMPY Savings
$2890
NPS Score
64
Star Rating
3.8★
Self-Insured Employer
Enrollment
1.9M lives
PMPY Savings
$5120
NPS Score
78
Star Rating
4.6★
ACO/CIN
Enrollment
2.4M lives
PMPY Savings
$4560
NPS Score
74
Star Rating
4.4★
5-Year Financial Impact (Per 100k Lives, $M)
Total 5-Year ROI: $38.1M cumulative savings
Break-even: Month 11
IRR: 147%
Population Health Risk Stratification
High Risk
12% of patients, 68% of costs
Rising Risk
23% of patients, 22% of costs
Moderate Risk
35% of patients, 8% of costs
Low Risk
30% of patients, 2% of costs
Implementation & Integration
EHR Integration
Epic MyChart
Cerner PowerChart
Athenahealth
HL7 FHIR R4
Real-time data sync
Implementation: 4-6 weeks
Reimbursement Codes
CPT 99453-99458 (RPM)
99490-99491 (CCM)
98980-98981 (Digital)
G2012, G2061 (Virtual)
0591T-0593T (Health coaching)
Implementation: Immediate
Quality Programs
MIPS/QPP reporting
HEDIS measures
Star Ratings
ACO quality metrics
CMS Innovation Center
Implementation: 90 days
147
Health Systems
18.3M
Covered Lives
$2.8B
Total Savings
92%
Contract Renewal